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Care Delivery

Anthem has been criticized and even sued over policies in several states where it won’t pay for emergency room visits it later determines to be unnecessary. The insurer has now softened those restrictions, but American College of Emergency Physicians (ACEP) said the changes don’t go far enough.

Purdue Pharma, best known for making and selling OxyContin, announced Feb. 10 that it will stop marketing opioid drugs to physicians. The company also stated it will lay off half of its sales force, with the remaining staff of 200 focusing on other medications.

Medicaid patients face a host of challenges in accessing care, with reliable, timely transportation often being a major consideration. A recently published study, though, showed rates of missed primary care appointments were unaffected when Medicaid patients were offered free ridesharing services.

Some 11.8 million people signed up for coverage through the Affordable Care Act (ACA)’s insurance exchanges for 2018, down from 12.2 million the year before. Considering changes that were expected to depress enrollment—like HHS shortening the open enrollment period for Healthcare.gov and cutting its advertising budget by 90 percent—signups “remained generally stable,” according to a report from the National Academy for State Health Policy (NASHP).

In 2011, as outlined in the Affordable Care Act (ACA), Medicare began offering wellness visits at no cost to fee-for-service beneficiaries. The goal of the annual checkup was to introduce preventative care and address specific risks such as depression and risk of falling.

When asked to identify what regulations are the most burdensome, physician practices pointed at the Merit-based Incentive Payment System (MIPS) being implemented as part of the Medicare Access and CHIP Reauthorization Act (MACRA).

The White House commission set up by President Donald Trump to address the nation’s opioid addiction “epidemic” has recommended declaring a national public health emergency, which would impact healthcare providers.

On July 26, CMS said 40 counties in the U.S. were projected to have no insurers offering coverage on Affordable Care Act (ACA) exchanges. By July 31, that number had shrunk to 19 after five insurance companies announced plans to participate in parts of Ohio.

The total number of licensed physicians has increased by 12 percent since 2010, with women and Doctors of Osteopathic Medicine (DOs) making up a greater share of the physician population, according to a report released by the Federation of State Medical Boards (FSMB).

There appears to be a direct link between hospitals’ initiatives to improve blood use stewardship and a 20 percent decrease in blood utilization for 134 diagnoses which make up 80 percent of red blood cell usage.

Most healthcare organizations with revenue under $1 billion surveyed by the Ernst & Young LLP Advisory Health practice reported having no value-based reimbursement initiatives and placed a lower priority on bundled payments and alternative payment models than larger systems.